Thanks to Eduardo Lacalle for his presentation of the Ultrasound case of the month yesterday at Elmhurst conference.Â Here’s a quick summary.
29M BIBEMS after assault.Â Intoxicated but awake and cooperative.Â Only complains of right eye and right flank pain. Vital Signs are stable.Â The patient has some superficial right periorbital abrasions.Â He is tender in the right upper quadrant and the eFAST exam reveals the following images.
Is there anything of interest noted here?Â What are your next steps?
Although no hypoechoic fluid is noted in the hepatorenal recess on these images, scanning through the kidney reveals a discontinuity of the parenchyma suggesting renal laceration in the second image (more obvious when the inferior pole was visualized per Dr. Lacalle). Â Urology was consulted and the CTÂ showed a large right perinephric hematoma with laceration at the lower renal pole.Â There was delayed contrast excretion but no avulsion of the ureter.
The patient was admitted to the SICU and during his subsequent hospital course required transfusion.Â Despite his Grade IV renal injury and blood loss, at angiography no active bleeding was noted, and he was able to be discharged 4 days after admission.
Take home message. Solid organ injury may be seen during your FAST exam.Â If there is time to scan through solid organs before your patient headÂ to CT, injuries may be noted.Â But remember, as Dr. Weingart said pointedly, the FAST exam is supposed to be just that – FAST.Â Don’t delay your patients CT or other evaluation searching for solid organ injury by Ultrasound.